android barcode scanner api java COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in .NET framework

Generation QR in .NET framework COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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CHAPTER 33 Depigmenting Agents
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FIGURE 33-1 The chemical structure of hydroquinone Hyperpigmented lesions, whether they are solar lentigos, freckles, or melasma, are the source of frequent complaints by cosmetic patients In addition, some cosmetic patients develop postinflammatory hyperpigmentation after chemical peels, laser treatments, or even after a bout of acne Melanin synthesis within melanosomes and their distribution to keratinocytes within the epidermal melanin unit determines skin pigmentation Hyperpigmentation occurs when this system goes awry (see 13) But dark spots and patches are unacceptable to cosmetic patients For this reason, there are hundreds of products on the market that are touted as lightening creams Although there are many product choices available, the number of effective agents to treat hyperpigmentation disorders is relatively small Unfortunately, most of these agents require months of use for improvement to be seen Combination with retinoids ( 30), sunscreens ( 29), chemical peels ( 20), and lights or lasers ( 24) may enhance the effectiveness of these products Currently available topical agents used to treat hyperpigmentation include tyrosinase inhibitors, melanosometransfer inhibitors, melanocyte-cytotoxic agents, retinoids, peeling agents, and sunscreens This chapter will discuss the ingredients commonly used for the treatment of pigmentary disorders
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Hydroquinone
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Hydroquinone (HQ) (Fig 33-1) is used in over-the-counter (OTC) products (2% concentration or less), prescription drugs (4%), and custom pharmacy formulations (2% to 10%) as an ingredient to inhibit melanin production and produce skin lightening The cosmetic products are often labeled as skin brighteners HQ also occurs naturally as an ingredient in various plant-derived food and beverage products, such as vegetables, fruits, grains, coffee, tea, beer, and wine1 For many years, HQ has been the main treatment modality for postinflammatory hyperpigmentation and melasma HQ exerts its depigmenting effect by inhibiting tyrosinase and by virtue of its cytotoxicity to melanocytes2 It is known to cause reversible inhibition of cellular metabolism by affecting both DNA and RNA synthesis Also, HQ is an efficient blocker of tyrosinase and has been shown to decrease its activity by 90%3 Although useful as a sole agent, HQ is often combined with other agents such as tretinoin, glycolic acid, kojic acid, and azelaic acid4 HQ is currently available as OTC in 2% concentrations and by prescription in 4% concentrations Although the 4% concentration is more effective than the more conventional 2% concentration, it is more irritating and may be more likely to lead to side effects such as skin redness Prolonged application of HQ, often 6 weeks or more, is necessary before any improvement becomes noticeable Numerous concerns about the safety of HQ have emerged in recent years and, in fact, its use was banned in Europe in 2000 for general cosmetic purposes In Asia, its use is highly regulated At the time that this chapter was written, debate was ongoing in the United States as to whether the FDA will ban HQ in OTC formulations Several companies have removed HQ from their products in anticipation of such a policy change In addition, many companies
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TYROSINASE INHIBITORS
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Tyrosinase, the enzyme that controls the synthesis of melanin, is a unique product of melanocytes (Fig 13-1) It is considered to be the rate-limiting enzyme for the biosynthesis of melanin in epidermal melanocytes Therefore, tyrosinase activity is thought to be a major regulatory step in melanogenesis Several products on the market contain ingredients that inhibit tyrosinase and thus decrease melanin formation
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with pharmaceutical products containing HQ that have not undergone the FDA approval process fear that the product will soon be banned by the FDA Currently, only Tri-Luma (Galderma) has been approved by the FDA for use in melasma The reason for this recent scrutiny is the fact that HQ is a metabolite of benzene and has potential mutagenic properties Some studies have shown that large doses of HQ delivered systemically not by topical application resulted in some evidence of cancer in rats However, HQ is detoxified in the liver in humans, but metabolized very differently in rats5,6 In humans, HQ is probably metabolized to detoxified derivatives, such as glucuronide and sulfate conjugates of HQ7 In the 40 years HQ has been on the market, no human cases of cancer have been attributed to its use The most serious human health effect seen in workers exposed to HQ is pigmentation of the eye and, in a small number of cases, permanent corneal damage1 The main concerns of the FDA are the side effects associated with topical use of HQ, which can lead to a condition called exogenous ochronosis8 Ochronosis presents as asymptomatic blue-black macules in the area of HQ application, which is basically a more permanent form of hyperpigmentation It usually occurs after prolonged use of HQ in concentrations of 4% and greater, which are only available by prescription However, ochronosis has also been reported to have resulted from the use of 2% HQ preparations9 Topical HQ products are thought to provoke this disorder by inhibiting the enzyme homogentisic acid oxidase in the skin This results in the local accumulation of homogentisic acid that then polymerizes to form ochronotic pigment10 Exogenous ochronosis seems to occur more commonly among patients with darker skin types Despite the widespread presence of HQ, only 30 cases of ochronosis have been attributed to its use in North America6 Other side effects like skin rashes and nail discoloration may also occur, but can be resolved by simply discontinuing HQ use The incidence of side effects may also be decreased through the use of lower strengths of HQ, using a test site first to determine the presence of allergy, and taking hydroquinone holidays every 3 months The debate in the FDA about the safety of HQ has increased the need for new depigmenting ingredients
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